July Intern--Taking Off My New White Coat

I became a doctor of internal medicine in my home country, the Philippines, in 2005. The following year, I immigrated to the United States. In order to practice medicine here, I must complete one more journey--a three-year medical residency in the U.S.

My first week at the hospital has been a hectic blur--one task right after another. I've been existing on minimal amounts of sleep, food and social contact and maximum amounts of coffee.

Inside my head, though, this week has also been all about me. How lucky I was to have been picked for this coveted residency in this highly regarded hospital! How can I regain my rusty diagnostic skills? How do I look in my new white lab coat?

Rushing here and there, checking on lab results, taking comprehensive histories from patients, doing my best not to miss a single differential in the most ordinary cases and trying to impress my seniors, I've felt a bit like Superman: I'm saving lives!

At times, I've slipped into a state of mind where every patient becomes just a room number and every diagnosis just a billing code with its corresponding treatment algorithms. When I'm in that zone, time passes quickly. I feel intelligent, even superior: I'm quite a doctor!

Then tonight happened.

Earlier today, a patient had been transferred to our floor from the ICU. She was a woman in her eighties with a beautiful French name--Françoise. Admitted for a severe lung infection, she'd taken a turn for the worse.

I spent the whole day running between Françoise's chart and the computer, following up labs, ordering medicines. But I knew that nothing I could do would save her. She probably had less than forty-eight hours to live.

As afternoon wore into evening, I passed her room yet again. She was asleep. An old man sat at her bedside, quietly holding her hand.

I remembered seeing him there this morning, when my medical team had discussed the infection, which was making her heart race dangerously. The man was, in fact, her husband.

Françoise's daughter had asked that we talk to him only when she was present--so that, if there was bad news, she'd be there to support him.

I sighed deeply, hoping that this momentary lapse of judgment wouldn't cost me too much time.

I walked into the room.

"Hi, how are you doing?"

He looked startled, then shrugged.

"How is she doing?"

I gave him a short update on Françoise's health status. Then, after an inner struggle, I mentally took off my white coat and sat down beside him.

"So, how are you holding up?" I asked.

This time he seemed to realize that I meant it.

"My name is Matthew," he said. "I know that my wife is very ill...I'm not sure how much you can help her."

He paused.

"If I lose her, though, how can I go on without her? We've been married for sixty-four years."

"Sixty years," I mumbled. "That's a long time."

"Sixty-four!" he corrected firmly.

I rested my back against the wall, trying to convey that I wasn't rushing to leave.

Suddenly Matthew's calm shattered. He began sobbing.

I tried say something consoling: "There are things we all have to accept...Let's hope for the best...."

I stopped. My words sounded empty; I felt stupid trying to tell a man twice my age anything about life. There was nothing I could do but be there with him.

After a bit, Matthew's sobs quieted.

"A few years ago, Françoise had a ruptured aortic aneurysm," he said. "She almost died. And I had bypass surgery. The doctors were surprised that I lived through it...Somebody up there must really like me."

They're survivors, I reflected. Two lucky survivors who care a lot for each other. Now, after sixty-four years together, she'll be gone.

Their plight reminded me of my own parents, of how difficult life had been for my mother after my dad had died. Her words echoed in my head: "It isn't true what they say, that time heals all wounds. Some pain you just don't ease from."

"Will she live through the night?" Matthew asked. "What if I leave, and she dies while I'm gone? I couldn't forgive myself."

I didn't know what to say. Should I lie? Deny the gravity of the situation and give him a little respite? Or tell him the truth and crush his last flicker of hope?

It's just not right, I thought. Look at this frail old man, quivering like a frightened puppy and wondering how he'll survive without his other half. He probably wishes he were in her shoes.

"My wife would kill herself if she saw her hair now," Matthew remarked.

Surprised, I laughed, then quickly silenced myself. He smiled slightly.

Françoise opened her eyes and stirred.

"She must have been listening," I said.

"No--she's hard of hearing," Matthew said, smiling again. He told me more stories of their life together. I listened until I could no longer ignore the inner voice nagging that I had more patients to see, more labs to follow up.

To walk away and leave a man in so much pain felt like a crime--I could sense the guilt written all over me. But I had to get on with my other tasks.

As quickly as I'd mentally taken off my white coat, I put it back on. Grabbing my stethoscope, I listened to Françoise's chest, checked her tracheostomy tube and prepared to go.

Matthew stood up and held out his hand.

"Thank you very much. You helped me a lot," he said.

I felt stunned--and guilty, still, that I couldn't do more.

Together, we sighed.

I wished Matthew well and left the room, trying not to imagine how he would get through the next few hours or days.

Walking away, I realized that, despite my clumsy efforts and sense of failure, I'd learned something new: This was the best medicine I'd practiced all day...And I was a better doctor when I took my white coat off than when I had it on.

About the author:

Heustein Sy is a second-year internal medicine resident at Overlook Medical Center in Summit, NJ. "Writing is an exercise to clear my mind and sort out the wrinkles in my chaotic life. As I put my thoughts down on paper, the noise that surrounds me fades, and I'm able to focus on the things that really matter."